Optimum Duration of Treatment With 6-Mercaptopurine for Crohn's Disease

Kim, Peter S.; Zlatanic, Jusuf; Korelitz, Burton I.; Gleim, Gilbert W.
November 1999
American Journal of Gastroenterology;Nov1999, Vol. 94 Issue 11, p3254
Academic Journal
OBJECTIVE: 6-Mercaptopurine (6MP) and azathioprine are immunomodulators used in the treatment of refractory Crohn's disease. Studies have confirmed their efficacy and value in maintenance of remission, but it is our purpose to determine how long 6MP/azathioprine should be continued once remission has been accomplished. METHODS: Careful follow-up was accomplished in patients with Crohn's disease seen at one medical center who were treated with 6MP for ≥6 months, who achieved remission within 1 yr of initiation of therapy, and who were in prolonged clinical remission (≥6 months without steroids). The time-to-relapse was calculated in those who continued treatment, in those who stopped treatment for reasons other than a relapse, and in the whole sample, taking into account that they could be treated with the drug, or could not, as a function of time. The influence of concomitant variables on the time-to-relapse rate was evaluated. RESULTS: A total of 120 patients met the inclusion criteria. The cumulative probabilities of relapse at 1, 2, 3, and 5 yr for those who continued to take 6MP and for those who stopped the therapy for reasons other than a relapse are as follows: Patients maintained on 6MP (n = 84): 1 yr, 29%; 2 yr, 45%; 3 yr, 55%; 5 yr, 61%. Patients who terminated 6MP (n = 36): 1 yr, 36%; 2 yr, 71%; 3 yr, 85%; 5 yr, 85%. Sex, distribution of disease, duration of disease, time to remission on 6MP, and concomitant 5-ASA use did not influence the relapse rates. Younger age was associated with a higher rate of relapse in patients who were maintained on 6MP. A higher daily dose of 6MP was associated with a higher relapse rate. CONCLUSIONS: Discontinuation of 6MP, while Crohn's disease is in remission, leads to higher relapse rates and continuation of 6MP reduces the likelihood of relapse. Therefore, we favor the indefinite use of 6MP once remission has been achieved.


Related Articles

  • Infliximab: A Review of its Use in Crohn’s Disease and Rheumatoid Arthritis. Siddiqui, M. Asif A.; Scott, Lesley J. // Drugs;2005, Vol. 65 Issue 15, p2179 

    Infliximab (Remicade®) is a chimeric monoclonal antibody against tumour necrosis factor (TNF)-α that has shown efficacy in Crohn's disease and rheumatoid arthritis with a disease-modifying activity and rapid onset of action. It is administered intravenously, generally in a schedule with...

  • Anti-TNF's for Postoperative Recurrence in Crohn's Disease: The If's and How's. Sorrentino, D.; Paviotti, A.; Fiorino, G. // Current Drug Targets;Feb2010, Vol. 11 Issue 2, p219 

    Recurrence of Crohn's disease (CD) is extremely frequent after surgery and its prevention remains a fundamental problem in the medical management of these patients. As of today, none of the medications traditionally used to treat the spontaneous disease (i.e. mesalamine, steroids,...

  • Azathioprine and 6-Mercaptopurine for the Prevention of Postoperative Recurrence in Crohn's Disease: A Meta-Analysis. Peyrin-Biroulet, Laurent; Deltenre, Pierre; Ardizzone, Sandro; D'Haens, Geert; Hanauer, Stephen B; Herfarth, Hans; Lémann, Marc; Colombel, Jean-Frédéric // American Journal of Gastroenterology;Aug2009, Vol. 104 Issue 8, p2089 

    OBJECTIVES:To evaluate the efficacy and safety of purine analogs (azathioprine, 6-mercaptopurine (6-MP)) in the prevention of postoperative recurrence in Crohn's disease (CD).METHODS:We searched MEDLINE, the Cochrane Library, and EMBASE. The primary end points, clinical and endoscopic recurrence...

  • Methotrexate in Crohn's Disease: Long-Term Efficacy and Toxicity. Lémann, Marc; Zenjari, Taoutik; Bouhnik, Yoram; Cosnes, Jacques; Mesnard, Bruno; Rambaud, Jean-Claude; Modigliani, Robert; Cortot, Antoine; Colombel, Jean-Frédéric // American Journal of Gastroenterology;Jul2000, Vol. 95 Issue 7, p1730 

    OBJECTIVE: A 16-wk, placebo-controlled trial has recently shown weekly low dose methotrexate to be an effective treatment for patients with chronically active Crohn's disease. The long-term efficacy and safety of this antimetabolite drug, however, are not yet well established and are assessed in...

  • Managing MS in a changing treatment landscape. Duddy, Martin; Haghikia, Aiden; Cocco, Eleonora; Eggers, Christian; Drulovic, Jelena; Carmona, Olga; Zéphir, Helene; Gold, Ralf // Journal of Neurology;May2011, Vol. 258 Issue 5, p728 

    Increasing options are dictating the development of new algorithms to provide guidance in the treatment of people with multiple sclerosis (MS). There is a wealth of evidence on the safety and efficacy of interferon-beta and glatiramer acetate, which have been used in Europe and in the United...

  • Digest. El-Omar, Emad; Vermeire, Severine; Gerbes, Alexander // Gut;Jun2010, Vol. 59 Issue 6, p1 

    The article presents information on several drug trials. One study compared the efficacy of beta-blocker therapy with cyanoacrylate injection for gastric variceal rebleeding prevention and found that rebleeding rate is significantly lower for the cyanoacrylate group. Another study compared the...

  • A Meta-analysis of Antimycobacterial Therapy for Crohn's Disease. Borgaonkar, Mark R.; MacIntosh, Donald G.; Fardy, John M. // American Journal of Gastroenterology;Mar2000, Vol. 95 Issue 3, p725 

    OBJECTIVE: Various therapies have been studied for the treatment of Crohn's disease, including antimycobacterial therapy. Meta-analysis was used to evaluate the effect of antimycobacterial therapy in patients with Crohn's disease, METHODS: Randomized, controlled trials comparing...

  • Takeda Announces GEMINI II Trial of Vedolizumab in Patients with Moderately to Severely Active Crohn's Disease Met Primary Endpoints of Improvement in Clinical Remission in Induction and Maintenance Phases.  // Biomedical Market Newsletter;5/12/2012, Vol. 21, p1 

    The article offers information on the release of doubleblindGEMINI II pivotal phase three clinical trials for a drug, vedolizumab developed by Takeda Pharmaceutical Company Ltd. for treating moderately to severely Active Crohn's Disease. The results show significant improvements in clinical...

  • Centocor/Johnson & Johnson: SONIC trial results support Remicade.  // PharmaWatch: Monthly Review;Dec2008, Vol. 7 Issue 12, p19 

    The article reports on the result of the clinical study of SONIC which demonstrates that Remicade is more effective than azathioprine monotherapy. The study further reveals that Remicade is significantly more effective than azathioprine monotherapy at inducing steroid-free remission and promotes...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics